Jonathan Hoiles: Perhaps 2 Units in Traumatic Hemorrhagic Shock Isn’t Enough to Make a Meaningful Difference?
Jonathan Hoiles, Manager of Transfusion Medicine and Blood Bank at Moffitt Cancer Center, shared on LinkedIn:
”Mixed messages?
Two similar studies recently published in the NEJM (TOWAR, a US study, and SWiFT, a UK study) reached similar conclusions: the use of up to 2 units of Whole Blood (WB) for injured pre-hospital patients with traumatic hemorrhagic shock is not superior to standard component therapy.
Yet, a systematic review of the literature published in Transfusion showed that WB is consistently associated with lower transfusion requirements compared to component therapy or crystalloids.
My take (perhaps a not-so-hot take?): 2 units of WB is insufficient for pre-hospital patients with traumatic hemorrhagic shock.
Given the large amounts of blood these massively bleeding patients require, perhaps 2 units isn’t enough to make a meaningful difference.”
Article 1: Prehospital Resuscitation with Type O Whole Blood for Trauma and Hemorrhage
Authors: Jason L. Sperry, Francis X. Guyette, Bryan A. Cotton, James F. Luther, Richard B. Utarnachitt, Matthew E. Kutcher, Brian J. Daley, Allan B. Peetz, Mayur B. Patel, Michael D. Goodman, Jeffrey A. Claridge, Nimitt Patel, Brian G. Harbrecht, Zain G. Hashmi, Ryan Zarychanski, Matthew D. Neal, Mark H. Yazer, Christian Martin-Gill, Laura E. Vincent, Ashley M. Harner, David E. Meyer, Andrew J. Latimer, Bryce R. Robinson, Catherine L. McKnight, William R. Hinckley, Keith R. Miller, Jan O. Jansen, Douglas Martin, Erin E. Fox, Bedda L. Rosario-Rivera, Stephen R. Wisniewski
Article 2: Prehospital Whole Blood in Traumatic Hemorrhage — a Randomized Controlled Trial
Authors: Jason E. Smith, Rebecca Cardigan, Emily Sanderson, Laura Silsby, Claire Rourke, Ed B.G. Barnard, Peter Basham, Grazia Antonacci, Richard Charlewood, Nikki Dallas, Jane Davies, Elizabeth Goodwin, Annie Hawton, Cara Hudson, Joanne Lucas, Katie Keen, Richard M. Lyon, Brodie Nolan, Gavin D. Perkins, Viona Rundell, Laura Smith, Simon J. Stanworth, Anne Weaver, Tom Woolley, Laura Green
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